District Nursing at a Glance. Matthew Bradby

nursing students undertaking the specialist practice community programme must demonstrate higher levels of judgement, discretion and decision‐making in clinical care. There are four key domains of specialist practice:

       Clinical practice

       Care and programme management

       Clinical practice development

       Clinical practice leadership.

      The educational curriculum for the district nursing programme must be based upon these four key domains, which must be achieved within theoretical modules and practice over a minimum of 32 weeks. The purpose of the practice placement is to ensure that students are exposed to Nursing and Midwifery Council (NMC) core and specialist competencies through individualised bespoke placements, which enables students to safely practise and achieve competency and autonomy in their professional programme. The NMC (Nursing and Midwifery Council, 2018b) set out the expectations for the learning, support and supervision of students in the practice environment, including how students are assessed for theory and practice. All students on an NMC‐approved programme, including district nursing students, must be supervised in practice by an NMC‐registered nurse who understands the proficiencies and programme outcomes they are supporting students to achieve. In addition, all students on NMC‐approved post‐registration programmes are assigned to a nominated practice assessor in accordance with relevant programme standards. The higher education institution (HEI) is also responsible for allocating a nominated academic assessor who works in partnership with the practice assessor to evaluate and recommend the student for progression, in line with programme standards.

      Students must document their learning within practice using a practice portfolio, as this is the vehicle for practice assessment for the duration of the programme. The practice portfolio should be developed throughout the duration of the programme. The portfolio should be used to guide and structure the students learning in practice, providing the opportunity for the student to work closely with their practice assessor and practice supervisor in order to identify learning opportunities that will meet agreed NMC competencies.

      Regular meetings between the student, academic assessor and practice assessor/practice supervisor are essential for successful practice portfolio development. Meetings should occur at specified times within the programme, such as an initial meeting, mid‐point and a summative meeting. The portfolio is as important as theoretical assignments as it provides evidence that supports the assessment of practice. Evidence must be provided for each of the four practice assessment domains, and all competencies must be successfully met. The practice portfolio should act as a medium for critical discourse between student, practice supervisor, practice assessor and academic assessor.

Placements should provide exposure to a range of learning opportunities. This may be achieved through the use of the ‘hub and spoke’ model, which can be adapted to local need, whilst building upon students’ prior knowledge, skills and experience. An alternative practice placement of a minimum of one week is suggested as good practice to enable the student to experience geographic differences in service delivery and a range of specialist services (Figure 4.1).

Both strategies enhance the students’ knowledge and skills and their understanding of inter‐professional and multi‐agency working. The district nursing team where the student is placed is the ‘Hub’ and this is the focus for the majority of the learning: the student would be exposed to the key domains of clinical practice, care and programme management, clinical practice development and clinical practice leadership. The ‘Spoke’ provides eclectic and individualised learning opportunities. Finding new ways in which to engage with the voluntary sector, support patient choice and sharing leadership with patients will be an increasing focus as district nurses find themselves involved in new care delivery models. Spoke placements with charitable organisations may prove significant in understanding how communities empower groups (Figure 4.2).

      User centrality is pivotal in the NHS strategy, and involvement of service users in healthcare improves partnerships, access to services and better service planning. Practice assessors and practice supervisors should identify patients or client groups with whom the student has contact, and ask them to complete user feedback on the student’s performance. Service user feedback should be sought at least once during each semester. This should act as a catalyst for discussion between the student, practice supervisor and practice assessor.

It is strongly advised that a placement contract is formulated between the student and the practice supervisor and practice assessor, as this may prevent problems arising in practice and can assist in the development of learning opportunities. Contracting ensures a structured approach to meeting the programme learning outcomes, allowing for negotiation and the development of a student‐centred placement experience that fosters professional development. The contract also facilitates realistic planning and the setting of achievable goals. Regular review of the contract allows for formative assessments and action plans to be revisited and changed as required. Occasionally there may be issues in practice and these need to be monitored and concerns actioned (Figure 4.3).

      During specialist practice, it is recommended that a series of action learning sets are undertaken. These action learning sets can be inter‐professional, facilitating understanding of professional roles and responsibilities, which may help to support the delivery of an integrated care workforce (Gilburt, 2016). The process is based on the idea that effective learning and development has to be about real problems in real life with real people (Raelin, 1998). Through action learning, individuals learn with and from each other by working on real problems and reflecting on their own experiences (Haydock and Evers, 2014).

      The benefits of action learning are:

       Greater breadth in understanding collaboration and inter‐professional learning to build up relationships in community nursing practice.

       Increased ability to analyse ambiguous situations and solve complex problems.

       Enhanced capacity to understand and initiate changes that increases the focus on what makes a difference in a situation.

       Better ability to be more action focused and proactive in delivering results.

       Enhanced self‐awareness and appreciation of personal impact on others, contributing to improved ability to work with others.

       Developed flexibility in responding to changing situations

       Shared knowledge and learning.

      Students are able to listen to and reflect upon others’ experiences, ask questions, gaining different perspectives (Pedler and Abbott, 2008). When members share information and resources, it provides practical and emotional support. The student and the practice assessor and practice supervisor should actively work together to participate in the action learning sets, which may be recorded and included as evidence in the portfolio.

5 Supporting nursing students in the community

       Josephine Gray, QN

Box 5.1 Examples of clinical skill experiences students may undertake during their community placement.

       Care of the diabetic patient, blood glucose monitoring and insulin administration.

       Continence advice and assessment and knowledge of incontinence products, order and supply.

       Tissue viability. Methods of wound assessment and correct choice of dressings. Venous and arterial leg ulcer management. Doppler assessment and compression bandaging. Pressure damage prevention and treatment and ordering of pressure‐relieving equipment.

       Medicines